The proposed study seeks to determine factors related to living kidney donor decision-making and outcomes. Recent technological advances now allow transplantation between biologically unrelated individuals. With more than 52,000 persons awaiting kidney transplantation, a number growing by 20% yearly, living donation is increasing rapidly. The Health and Human Services Advisory Committee on Transplantation stressed the need for study of living donor decision-making and outcomes. Most transplant centers emphasize autonomous decision making yet, some donors prefer shared family decision-making. Blacks make up 12% of the U.S. population and over 30% of those with end stage renal disease. However, only 15% of living organ recipients are black and blacks are less likely to be living donors than whites. Further study is needed of living donor decision-making in diverse populations. Also, recent studies reveal important declines in the health status of living donors. The proposed study will survey 189 live kidney donor candidates. Using a descriptive comparative longitudinal design, subjects will be tested during donor evaluation and at 3, 6, and 12 months after surgery to examine donor decision-making and outcomes. A sub-sample will be interviewed qualitatively to provide data that will complement and enrich the quantitative findings. Specific Aims: 1. To examine the association between relational factors (marital status, health care decision control preference, and support for donation) and the way in which the decision to donate is made (donor decision control). 2. To determine pre- to post-transplant changes in functional status, work hours, and family stress in living donors. 3. To describe donor perceptions of complications of kidney donation at 3, 6, and 12 months after surgery. 4. To determine the effect of donor-recipient relationship and trust in the transplantation professionals on satisfaction with donation. 5. To describe the relationship of age, race, gender, and educational status to satisfaction with donation. 6. To explore the meaning of the decision to be a living kidney donor in a culturally diverse sample of living kidney donor candidates. [unreadable] [unreadable]